| NPI | 1154315711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD072803L) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DE C10005739) |
| 208000000X Pediatrics (Licence: DE C10005739) | |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2011-08-03 |